Public Health Care in India

Public Health Care : India
An Overview
State Institute of Health & Family Welfare, Jaipur
SIHFW: an ISO 9001: 2008 certified Institution 1

Constitutional commitment:
Health: State subject
Central List
International Health, Port Health
Research
Technical & Scientific Education
State List
All other Health issues
Concurrent list
Epidemics

 Mile Stones:

NRHM-2005
 NHP-2002
 NPP-2000
 RCH-1996

 UIP-1985
 NHP-1983

 Alma Ata-1978
 Small pox eradicated-July 5, 1975

 NFPP-1952
 India Joins WHO-1948

 HSDC-1946
• SIHFW: an ISO 9001: 2008 certified Institution 3
 Pop. Policy Draft 1976
 Small pox free-July 5, 1975 &

ICDS started

 MTP Act-1969(1972)
 Birth & Death Reg. Act-
1969
 FW-1966
Juggling
Priorities
 NSEP-1962
 NMCP to NMEPP-1958
 CHEB-1956
 BCG Vaccination-1951
 NMCP & NFPP-1951
 India joins WHO- 1948
 1947
 HSDC-1946 SIHFW: an ISO 9001: 2008 certified Institution 4

NRHM-2005
 NVBD CP(03-
04
 National Health
Policy-
2002
 National Pop. Policy-
2000
 RCH-1997
 Target free approach
-1996
 Beijing conference-1995
 Legislation on Transplantation
of human organs enacted

1995
ICPD-1994
SIHFW: an ISO 9001: 2008 certified Institution 5

 ICDS renamed
Integrated Mother and
Child Development
(IMCD) 1995
 CSSM-1992
 National Blood safety
program- 1989
 NACP -1987
 UIP-1985
 NLCP-NLEP, 1983
 NHP-1983
 Alma Ata-Declaration( 1978)-HFA-2000
 NFWP-1977

Ø NO Health Policy for 36 years
Ø Committees and Commissions
Ø Single issue addressed by Committee
Ø Comprehension was missing
Ø recommendations- reiterations of Bhore Committee
Ø Individual “Health” Programs - situational exigency
Ø Uni-purpose workers later baptized as Multi-purpose
Ø Programs worked in complete isolation till 1980 (e.g.
NTCP)
Ø Fragmented approach to Health

Still…62 yrs. of Health Services
ØCrude Death Rate ↓

ØCrude birth rate ↓
ØLife expectancy ↑
ØS.pox & G. worm eradicated
ØLeprosy eliminated
ØIMR ↓
ØInfrastructure – expanded

Core Functions of Public Health
Ø Well developed administrative system
Ø Skills
Ø Reasonable Infrastructure
ØPoor health outcomes
Ø Design
Ø Misdirected efforts

Five year Plan Period Major areas addressed
I 1951-55 Infrastructure
II 1956-61 Industry
III 1961-66 Panchayat & Green Revolution
IV 1969-74 Expenditure, Agriculture
V 1974-79 Agriculture
VI 1980-85 Health, Technology
VII 1985-89 Poverty, Agriculture & Justice
VIII 1992-97 Pop., Agriculture, Poverty
IX 1997-02 Employment, Basic facilities
X 2002-07 HRD, Industry, Technology
XI 2007-12 Education, Health, Empowerment
Bhore Committee, 1946
 PHCS : nodal points for Health care

 Phased expansion
 Prevention stressed

 Population based


Health –State Subject ?
Ø Centralized planning
Ø Decentralized implementation
Ø Fiscal control of central Govt.
Ø Centre dictates States for Objectives &
Priorities

Health Care in India
Ø Entitlements by policy and not rights
Ø Focus on preventive and promotive care
Ø Grossly under-provided facilities
Ø Poor investments hitherto
Ø Declining public expenditures and new
investments
Ø Structural Adjustment programming under
World Bank dictate

Service Delivery:3-tier Structure
CHC
PHC
SC
Underutilized for-
Services
Supplies
Funding
CHC
3043 1: 100000 (Plains)
1:80000 (Hilly/ Tribal)
PHC 1:30000 (Plains)
23500
1:20000 (Hilly/Tribal)
137407
HWF-134000 Sub- Centers 1:5000(Plains)
HWM-73000 1:3000 (Tribal/ Hilly)
640000 Villages-AWW/ SBA/ VHG/ ASHA

1027 million People-2001
Committees & Commissions

1959-62 Mudaliar committee (Health
Survey And Planning Committee)
Ø Consolidate gains
Ø Strengthen district hospitals
Ø Regionalization of health services
Ø PHC for 40000 population
Ø Integration of medical & health
Ø Creation of all India health services cadre
Ø

1963: Chaddah Committee
Ø TOR-Malaria
Ø NMEP
Øvigilance & maintenance by
health services
ØMonthly home visits
Ø10000 population per worker
Ø Basic health worker
Øvital statistics &
Øfamily planning
Ø
1964: Mukherjee Committee
Ø TOR-Family planning
Ø Exclusive family planning staff
(uni-purpose worker)
Ø

1964-67: Junglewala Committee
(Integration Of Health Services)
Ø Unified cadre
Ø Common seniority
Ø Recognition of extra qualifications
Ø Equal pay
Ø Specialized pay
Ø No private practice
Ø

1972-73: Kartar Singh Committee
Ø Conversion of ANM to MPHW (F)

Ø Uni-purpose to multi-purpose workers
Ø One PHC per 50000 population
Ø16 S/C per PHC
Ø3000-3500 population per
S/C
ØOne supervisor for 4 workers

1974-75: Srivastavcommittee (Medical
Education & Support Man-Power
Committee)
Ø Cadre of community health workers (CHW)
Ø Medical officer for maternal health at PHC
Ø Heath assistant to be a link between health
worker and PHC

Population and Growth: India

Demographic Facts
ØSecond most populous country in the

world
Ø17% of world’s population in 3% of earth’s
land area
ØLast century
ØGlobal population increased 3 times
ØIndia’s population increased 5 times
Ø2030: Population to exceed that of China

Marriage and Fertility

Marital Status
Percent of women age 20-24 married by age 18
54 53
50
45
28
NFHS-1 NFHS-2 NFHS-3 Urban Rural
NFHS-3

Mean Age at Marriage for Boys-Years
35
29.6
30 28.3 28
26.7
26.1 25.3 24.7
25 23.8
21.6
22.8 22.9
21.8 21.6
20.7
20
15
10
5
0
A
O
G
K
JR
P
M
J
A
R
N
T
T
H
C
R
A
K
R
E
K
S
R
O
N
O
P
P
U
IH
B
P
A
B
W
DLHS-3 DLHS-2

Percentage of Girls Married below Age 18

Marriage (DLHS-3)
Ø Rajasthan is the only state where mean age at
marriage for boys and girls is lower than the legal
age at marriage
Ø Bihar is the other state where female mean age at
marriage is lower than legal age. Bihar reported
the lowest (17.6 years) mean age while it was the
highest in Goa (25.1 years)
Ø In case of males, Goa reported the highest (29.6
yrs) while Rajasthan (20.7 yrs) reported the
lowest
Ø % of females marrying before reaching 18 years of
age had come down in high-focus states yet it
has a long way to go to attain the stage reached
by Kerala and SIHFW:
Goa. an ISO 9001: 2008 certified Institution 35
Age Specific Fertility rate
Source NFHS III

Problems:
Ø Indirectly related to Ø Directly affecting Health
health ØDiseases
ØEnvironment ØCommunicable
ØEducation ØNon
ØEmpowerment Communicable
ØNew emerging
Ø
ØFertility
Ø ØPopulation
ØGrowth rate
ØTotal Fertility
ØNutrition
ØMalnutrition
ØObesity
Ø
Problems- Why
Ø Access
Ø Availability
Ø Utilization

Health Care in India
Ø Entitlements by policy and not rights

Ø Focus on preventive and promotive care
Ø Grossly under-provided facilities
Ø Poor investments hitherto
Ø Declining public expenditures and new
investments
Ø Structural Adjustment programming under
World Bank dictate

Policies
Ø NHP-1983…….NHP-2002
Ø NPP-2000

NHP-1983
Ø Re-orientation of Medical education
Ø Re-structuring and Re-organizing the then
existing health care services
Ø Population stabilization
Ø Re-orientation of existing health personnel
Ø Role of practitioners of ISM in Health care
delivery
Ø Goals -
ØAchievement?
ØCDR & Life expectancy

NHP-2002
Ø Averages of health indices hide disparities
Ø large gap in facilities still persists
Ø shortfall in the number of SCs/PHCs/CHCs is
of the order of 16 percent. (CHC-58%)
Ø ‘Vertical’ implementation structure -extremely
expensive
Ø the rural health staff has become a vertical
structure exclusively for the
implementation of family welfare activities
Ø Low utilization-20 % seeking OPD services,
<45 percent seeking indoor treatment, go to
public hospitals.

Policy Prescriptions-NHP-2002
Ø Increase health sector expenditure to 6 %of
GDP
Ø Increased allocation (55 %)for the primary health
sector
Ø Gradual convergence of all health programs
Ø Developing the capacity
Ø Strengthening of the primary health
Ø User charges
Ø Contract employment
Ø Manpower deployment norms
Ø
Ø Integrated disease control network
Ø Increase in postgraduate seats in Public
Health & Family Medicine
Ø Decentralization- Role of LSG/ NGO
Ø Medical Grants commission
Ø legislation for regulating clinical
establishments/medical institutions by
2003
Ø SIHFW: an ISO 9001: 2008 certified Institution 49
Goals to be achieved by 2000-2015
Eradicate Polio and Yaws 2005
Eliminate Leprosy 2005
Eliminate Kalazar 2010
Eliminate Lymphatic Filariasis 2015
Achieve Zero level growth of HIV/AIDS 2007
Reduce Mortality by 50% on account of TB, Malaria 2010
and Other Vector and Water Borne diseases
Reduce Prevalence of Blindness to 0.5% 2010
Reduce IMR to 30/1000 And MMR to 100/Lakh 2010
Increase utilization of public health facilities from 2010
current Level of <20 to >75%
Establish an integrated system of surveillance, 2005
National Health
NPP-2000

 NPP-2000
 TFR-2.1 : 2010

 May 11, 2000: Pop.-1

Billion

 July 1993

 NHP-1983:
( Replacement TFR (2.1) by 2000)

 NFWP-1977
 Cafeteria, Education,
Motivation, Compulsion,
Incentive, Target free

June, 1977
 April 16, 1976
 NFPP-1952
National Pop. Policy Objectives
ØImmediate
ØTo address the unmet needs for
ØContraception
ØHealth care infrastructure
ØHealth personnel
ØTo provide integrated service delivery
for basic reproductive and child
health care
ØMedium
ØTo bring TFR to replacement levels by
2010
ØLong term
ØTo SIHFW:
achieve a stable population by 2045
an ISO 9001: 2008 certified Institution 52
Challenges
Ø Manpower- Number & Norms

Ø Rural/Urban differential
Ø Geographical divide across States
Ø S-E groups- accessibility/reach
Ø Gaps between Policy & Action
Ø Health sector expenditure
Ø Newer Infections
Ø

Rural : Urban Differentials in Health
Status
Sector Pop. IMR/ <5Mort-ality Weight For
BPL (%) Per 1000 Per 1000 Age-% of
Live (NFHS II) Children
Births Under 3
(1999 years
India 26.1 70
SRS) 94.9 47
(<2SD)
Rural 27.09 75 103.7 49.6
Urban 23.62 44 63.1 38.4

Rural-Urban Disparities – India
Rural (per 1000 population)

 Urban (per 1000population)
Ø Hospital Beds = 0.2 Ø Hospital Beds = 3.0
Ø Doctors = 0.6 Ø Doctors = 3.4
Ø Public Expenditures = Ø Public Expenditures =
Rs.80,000 Rs.560,000
Ø Out of pocket = Ø Out of Pocket =
Rs.750,000 Rs.1,150,000
 ________________
 ____________________
Ø IMR = 74/1000 LB
Ø IMR = 44/1000 LB
Ø U5MR = 133/1000 LB
Ø U5MR = 87/1000 LB
Ø Births Attended =
33.5% Ø Births Attended =
Ø Full Immunz.=37% 73.3%
Ø Median ANCs=2.5 Ø Full Immunz.= 61%
– Ø Median ANCs=4.2
Differentials in Health Status
Among States
Better Pop. IMR/ <5Mort- Weight For MMR/ Leprosy Malaria
States BPL (%) Per ality Age- Lac cases per +ve
1000 Per % of (Annual 10000 Cases in
Live 1000 Children Report populatio year 2000
Births (NFHS II) Under 2000) n (in
(1999 3 years thousand
SRS) (<2SD) s
Kerala 12.72 14 18.8 27 87 0.9 5.1
Maha. 25.02 48 58.8 50 135 3.9 138
TN 21.12 52 63.3 37 79 4.1 56

Poor Pop. IMR/ <5Mort- Weight MMR/ Leprosy Malaria
States BPL Per ality For Age- Lac cases +ve
(%) 1000 Per % of (Annual per Cases in
Live 1000 Children Report 10000 year
Births (NFHS II) Under 2000) populati 2000 (in
(1999 3 years on thousan
SRS) (<2SD) ds
Orissa 47.15 97 104.4 54 498 7.5 483
Bihar 42.60 63 105.1 54 707 11.8 132
Raj. 15.28 81 114.9 51 607 0.8 53
UP 31.15 84 122.5 52 707 4.3 99

Differentials in Health Status
Among Socio-Economic Groups
Indicator Infant <5 Mortality % Children
Mortality Underweight
India 70 94.9 47
Social Inequity
S/C 83 119.3 53.5
S/T 84.2 126.6 55.9

OBC 76 103.1 47.3
Others 61.8 82.6 41.1

Health Care Governance in India

Health System’s Organization-India
 Central Govt.

Planning Commission National Development Council
 CCHFW

MOHFW




 FW Medical & Public Health ISM&H
 Secretary Secretary Secretary
 Jt.Secy. Addl.Secy. Director
 Director Jt.Secy. Jt.Secy.
 DGHS
 Addl.DGHS

National Developmental Council
Highest constitutional Policy making body
Approves Policies and strategies for development
Composition:
 Chairman- Prime Minister
 Members- Central Ministers
 Chief Ministers
 Lt.Governors& Administrators of
UTs
 Dy. Chairman & members of
Planning Commission

Planning Commission
Constituted on March 15,1950
Composition: Chairman— PM
 Dy. Chairman
 Members 5-7(Full time)
 2-3(Part time)
Functions :

Ø To Assess & augment resources-Man, Money,

Material
Ø To Formulate Plan for utilization of resources
Ø To Decide on priority based phased implementation
Ø To Decide on nature of executing machinery
Ø To review the Periodic progress
Ø To Make appropriate interim recommendations

MoHFW
Ø Official Organ of health & Family

welfare at National Level
Ø Headed by Cabinet Minister, Minister of
State & Deputy Health Minister
Ø Functions
Ø Union List
Ø Concurrent List

Role of Central Govt. in Health Care
Ø Policy formulation
Ø Maintaining International health relations
Ø Administration of central health institutions
Ø Regulating Medical education through statutory
bodies-MCI/DCI/Councils
Ø Medical & Public health research-funding
Ø Standards- laying &
maintenance(Drugs/Education)
Ø Coordination-Other ministries/States/Statutory
bodies
Ø Central Health Acts
Ø Negotiation with International agencies

Functions of Dept of Family Welfare
Ø Policy preparation & Planning
Ø Information collection & Evaluation
Ø Contraceptive-Research /Supply
Ø Seeking International support
Ø EPI/UIP/CSSM/RCH/ARI/ORT-Trainings &
area development
Ø IEC
Ø Rural Health
Ø Paraprofessional training
Ø NGO support
Ø Development of Sub-center
Ø
Functions of Medical & Public
Health Dept.
Ø Health Policy preparation
Ø National Health Programs conduction
Ø Drug Control
Ø PFA enforcement
Ø Diseases control-
Communicable/Non-communicable
Ø Supplies & Disposal Maintenance
Ø CME & Trainings
Ø Medical Education & Research
Ø Vital statistics & Health intelligence
Ø International support
Ø
Organization at State Level
 State Government

Minister Medical Education MoH & FW

Secretary-ME
 Principal Secretary-Health Secretary-FW


Principals Directors (Service divisions)

(Medical Education)
 FW Public Health AIDS IEC


 Addl. Directors
 Jt. Directors
 Dy. Directors
 State Program Officers
 Zonal Directors


District Health Care Administration

District
 An Administrative unit
 which has
 Defined Geographical boundary and
Population
Ø Peripheral most Planning unit
Ø A self contained segment of National Health
System


District Health Organization
 CMHO PMO
 (Rural),Preventive (Urban),Curative

 Dy.CMHO Program Officers
 (registered society-DHS)
 CHC
 Pop.-80000-120000
Beds(30)
 Specialists(7-IPHS)
 Referral
 P H C (20-3000)
 Primary health
 Medical Officer(2-IPHS)
 SC (3-5000)HW-M/F
 SBA/AWW/VHG/ ASHA


Functions of District Health System
Ø Liaison between Field units & Headquarter
ØField reports
ØInspections
ØMeetings
Ø Implementation of Policy & Programs
Ø District level planning & Action Plans
Ø Rationale use of Finance & Resources
Ø Communication Management
ØPlans/Schedules/Progress/Problems
Ø Control & Monitoring

Problem Areas at District
Ø Quantity v/s Quality
Ø Cluttered Policy guidelines
Ø Decentralization on papers
Ø Roles/Responsibilities poorly defined
Ø Program integration?
Ø HMIS-generation & use?
Ø Managerial skills
Ø Donor initiative – “Societies”
Ø Resource restriction

Health- A Dynamic Phenomenon
Health System ought to be, for-

Ø Rising costs
Ø Changing political situations, and
Ø Social contexts (expectations of
people from System)


Core Functions of Public Health
Ø Monitoring health situation
Ø Disease surveillance
Ø Health promotion
Ø Regulations
Ø Partnerships
Ø Planning & Policies
Ø HRD
Ø Reducing impact of emergencies on
 health

System?
 A set of interrelated and independent

parts designed to achieve a set of goals

Health System ?
Structure & functions of a Country’s MoH having

ØResources
ØManagement
ØOrganization
ØEconomic support
ØService delivery as it’s main component

 SIHFW: an ISO 9001: 2008 certified Institution 76

Development of Health Systems
Ø Organization-changes in character with time
Ø Resource expansion
Ø Increase in utilization
Ø Increase in expenditure & Financing pattern of health
care
Ø Cost-control strategies & Increasing system’s efficiency
Ø Technological advances-demand & application
Ø Prevention emphasized
Ø Quality assurance
Ø Public-Private interaction
Ø Pattern of service delivery
Ø Public participation in Policy decisions

Why Study Health Systems?
Ø To provide perspective to understand self

Ø To observe & examine strategies for achieving
equity under different situations
Ø To draw generalizations
Ø To create System’s influence on health status
Ø

National Health Systems
Issues :

Ø Generalizations of performance & trend

Ø Political dimensions-Dynamism
Ø Forces deciding character
Ø Impact on Health
Ø Relevance to human rights

Development of Health Systems
Ø Organization-changes in character with time
Ø Resource expansion
Ø Increase in utilization
Ø Increase in expenditure & Financing pattern of health
care
Ø Cost-control strategies & Increasing system’s
efficiency
Ø Technological advances-demand & application
Ø Prevention emphasized
Ø Quality assurance
Ø Public-Private interaction
Ø Pattern of service delivery
Ø Public participation in Policy decisions
Ø SIHFW: an ISO 9001: 2008 certified Institution 80
Components of Health System
Ø Production of Resources
Ø Organization of Programs
Ø Economical support
Ø Management
Ø Delivery of Services

Health- A Dynamic Phenomenon



Health System ought to be, for:
ØRising costs
ØChanging political situations
ØSocial contexts(expectations
of people from System)


Basis of Classification
ØIn relation to service delivery

ØBased on nature of service
ØBased on doctrine
ØIn relation to traditional Medicine
Ø

Based on Service Delivery


Ø Public Sector
Ø Private sector
Ø Primary Care
Ø Trust Hospitals
ØPrimary
Health Ø Corporate
centers Hospitals
ØSub centers Ø Nursing Homes
Ø Secondary care Ø Medical
ØCHC Insurance
ØHospitals Ø
Ø Tertiary care Ø Others
ØTeaching Ø NGOs
Hospitals
Ø Voluntary
Ø agencies
Ø Others
Ø Defense 

Ø Railway & ESI
Based on Nature of Service
ØIndigenous-Rural
ØGeneral care
ØSpecialty
ØSuper specialty/Corporate

Based on Doctrine
Ø Official
ØAllopathic
Ø Traditional
ØAyurveda
ØUnani
ØSiddha
ØHomeopathy
ØChinese
ØTibetan
Ø
Ø
Allopathic/Modern System
[Cost, Coverage, Coordination & Culture]
Ø Ø
Ø Strengths Ø Weaknesses
Ø Systematic Ø Cost
Ø Strong Data base Ø Isolated
Ø Pharmacopoeia approach-
Ø Diagnostic Anatomical
approach
support Ø Dependence on
Ø Quick technology
Ø Interventional Ø Human touch
procedures missing
Ø Epid. Ø Iatrogenic
developments disease
Ø Ø Voracious
resource eater
Ø Drug use-
irrational
Traditional
[Ethno/Alternative/Indigenous]
Ø Root - acceptability
Ø Respect of healers
Ø Reach in masses
Ø Rural base
Ø Renaissance/Re-birth
Ø Role in present system
Ø

Types of Health Systems in Relation to
Traditional Medicine
Ø Exclusive (tolerant) : UK, Germany


Ø Inclusive : India, Pakistan, Burma,

Sri Lanka, Bangladesh,
Thailand

Ø Integrated : China, Nepal

Public Health: Rajasthan

Ø India’s largest State:
Ø3.42 lakh sq. kms
Ø33 Districts
Ø241 Tehsils, 237 Blocks
Ø Rajasthan accounts for:
Ø10.4% of the country’s
area
Ø5.49% of its population
Ø10.6% of the cultivated
area

Health Infrastructure: March 31, 2009
SC : 10742
PHC: 1503
CHC: 367
DH: 33
Satellite hospitals: 06
SDH: 12
City dispensaries: 199
•
Ø Special recruitment drive with hard duty
allowances

Ø Sanjivani scheme for providing specialist services

in tribal and desert areas through health camps

Ø Swasthya Chetna Yatra: 31 lakh people benefited

through multi-speciality health check camps at

panchayat headquarters.
Ø Mukhya Mantri Balika Sambal Yojana: Rs. 10,000
to be given to each girl (max 2) on family

planning adopted by parents without boys.
Ø Free Medicines to senor citizens, BPL and

pregnant women in up to 50 bedded CHCs
Ø Promotion of generic medicines at lower cost
Ø Doctor aap ke Dwar Yojana: 52 Mobile Medical Vans
 for far-flung areas in all districts (Rajasthan Firsts)
Ø Charak Aapke Dwar Yojana: free surgical services at
 rural areas
Ø Rajasthan University of Health Sciences (Rajasthan
Firsts)
Ø MoU with North Shore Hospital, New York for
 upgradation of infrastructure in health care institutions
 and medical research cooperation (Rajasthan Firsts)
Ø Telemedicine being implemented with ISRO support,
 connecting 6 medical college hospitals with 32
district
 hospital and 1 block (Rajasthan Firsts)
Ø Policy to promote private investment in Health
 Care Facilities SIHFW: an ISO 9001: 2008 certified Institution 94
Challenges
Ø Manpower- Number & Norms
Ø Rural/Urban differential
Ø Geographical divide across States
Ø S-E groups - accessibility/reach
Ø Gaps between Policy & Action
Ø Health sector expenditure
Ø Newer Infections
Ø
Performance, Progress & Punctuations

Health Care Infrastructure : India

Infrastructure development:
Rajasthan
12000
10000
8000 PHC
6000 SC
m
N
b
u
e
4000 CHC
r
2000
0
1 2 3 4 5 6 7 8 9 10
FY Plan

Human Resource in Health

Source :CBHI

Medical Education
Source MCI/DCI/INC
Colleges India Rajasthan

Medical Colleges 300 10
Recognized 211 7
Non Recognized 89 3
Dental Colleges 290 13
Recognized 154 8
Non Recognized 136 5

Performance

Health Expenditure Patterns

Some Facts
Ø 1125000 Practitioners, 125000 in Govt., 59% in
cities
Ø 49% of beds, 42% of occupancy (private sector)
Ø 40 Doctor/100000, 32 Nurses/ 100000 pop.
Ø(National average-59/ 100000,
79/100000)
ØDeveloped country average: 200/
100000
Ø 76 drugs (25% of essential) under price control
Ø 50% of spending in health is on drugs
Ø < 1% of GDP
Ø Proportion of Total Health Exp.: Govt-20%
Ø Private health exp.:
Ø80% of total health cost
Ø97% : OOP
Ø One hospitalization: 60% of annual income
Ø Outpatient care accounts for 61 per cent of
private healthcare spending

 People are resources
 But
 To maintain this resource
 We need Resources

Who Pays?
Ø Health Authority?
Ø Government?
Ø Taxpayer?

Status of Expenditure in Five Year Plans
FYPs Total Plan Health Family Welfare
I Investment
1960 65.2 0.1
II 4672 140.8 2.2
III 8576 225 24.9
IV 15778.8 335.5 284.4
V 39322 682 497.4
VI 97500 1821 1010
VII 180000 3392 3256.2
VIII 798000 7575.9 6500
IX 859200 10818 15120.2
X 1484131.3 31020.3 27125
XI NA 46669 89478

Expenditure Patterns
Ø Public expenditures – declining trends


Ø Out of pocket – increasing burden,

especially the poor and in rural areas

Health Spending: Facts
Ø Public Domain
ØCenter: Rs.35 bi (0.13% GDP)
ØState: Rs.186 bi (0.72% GDP)
ØLocal: Rs.25 bi estimated (0.10% GDP)
ØSocial Insurance: Rs. 12 bi (0.05%
GDP)
Ø Private Domain
ØOut-of-pocket: Rs.1200 bi (4.62% GDP)
ØInsurance (public sector) Rs.8 bi (0.03%
GDP)
ØPharma Industry Rs. 250 bi (0.96%
GDP)
Budget: Rajasthan
120000
100000
80000
Rs. in Lacs 60000

40000
20000
0
1 2 3 4 5 6 7 8 9 10
Five year Plans

Health Legislations in India

A. Legislations Related to Health in
General
Ø The Epidemic Diseases Act, 1897
Ø Indian Air Craft (Public Health) Rules, 1954
Ø The Registration of Births and Deaths Act, 1969
Ø The Persons with Disabilities (Equal
Opportunity, Protection Of Rights & Full
Participation) Act, 1995
Ø Legislation on Transplantation of human organs,
enacted 1995
Ø The Biomedical Waste (Management And
Handling Rules 1998) Act
1.

3. SIHFW: an ISO 9001: 2008 certified Institution 166

B. Legislation Related to Mother/
women’s Health
Ø Hindu Marriage Act, 1955
Ø The Special Marriage Act, 1954
Ø Hindu Succession Act, 1956
Ø The Maternity Benefits Act, 1961
Ø The Dowry Prohibition Act, 1961
Ø Hindu Adoption and Maintenance Act, 1956
Ø The Immoral Traffic (Prevention) Act, 1956;
amended in 1986
Ø The Immoral Traffic (Prevention) Act, 1956;
amended in 1986
Ø Medical Termination Of Pregnancy Act, 1971
 (The MTP Rules, 1975)
Ø Pre-natal Diagnostic Techniques (Regulation &
Prevention of misuse) Act,1994;Rules, Nov.26,
1996 SIHFW: an ISO 9001: 2008 certified Institution 167
C. Legislations Related to Child Health
Ø The Child Marriage Restraint Act,1929

Ø Children Act, 1960
Ø The Juvenile Justice Act, 1986
Ø The Child Labor (Prohibition and Regulation)
Act, 1986
Ø Infant Milk substitute Act, 1992


 Thank You

Public Health Care in India

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Public Health Care : India

State Institute of Health & Family Welfare, Jaipur

SIHFW: an ISO 9001: 2008 certified Institution 1

SIHFW: an ISO 9001: 2008 certified Institution 2

of human organs enacted

SIHFW: an ISO 9001: 2008 certified Institution 6

SIHFW: an ISO 9001: 2008 certified Institution 7

ØCrude Death Rate ↓

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 PHCS : nodal points for Health care

SIHFW: an ISO 9001: 2008 certified Institution 11

SIHFW: an ISO 9001: 2008 certified Institution 12

SIHFW: an ISO 9001: 2008 certified Institution 13

HWM-73000 1:3000 (Tribal/ Hilly)

640000 Villages-AWW/ SBA/ VHG/ ASHA

SIHFW: an ISO 9001: 2008 certified Institution 16

SIHFW: an ISO 9001: 2008 certified Institution 17

SIHFW: an ISO 9001: 2008 certified Institution 19

SIHFW: an ISO 9001: 2008 certified Institution 20

Ø Conversion of ANM to MPHW (F)

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SIHFW: an ISO 9001: 2008 certified Institution 22

SIHFW: an ISO 9001: 2008 certified Institution 23

ØSecond most populous country in the

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SIHFW: an ISO 9001: 2008 certified Institution 31

NFHS-1 NFHS-2 NFHS-3 Urban Rural

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SIHFW: an ISO 9001: 2008 certified Institution 34

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Ø Entitlements by policy and not rights

SIHFW: an ISO 9001: 2008 certified Institution 44

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 May 11, 2000: Pop.-1

Ø Manpower- Number & Norms

SIHFW: an ISO 9001: 2008 certified Institution 53

Rural 27.09 75 103.7 49.6

Urban 23.62 44 63.1 38.4

SIHFW: an ISO 9001: 2008 certified Institution 54

Kerala 12.72 14 18.8 27 87 0.9 5.1

Maha. 25.02 48 58.8 50 135 3.9 138

TN 21.12 52 63.3 37 79 4.1 56

SIHFW: an ISO 9001: 2008 certified Institution 56

Orissa 47.15 97 104.4 54 498 7.5 483

Bihar 42.60 63 105.1 54 707 11.8 132

Raj. 15.28 81 114.9 51 607 0.8 53

UP 31.15 84 122.5 52 707 4.3 99

SIHFW: an ISO 9001: 2008 certified Institution 57

S/T 84.2 126.6 55.9

Others 61.8 82.6 41.1

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Ø To Assess & augment resources-Man, Money,

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Ø Official Organ of health & Family

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